Question

Gastroenterology Consultation Report

Reason for Consultation:          Evaluation of recurrent epigastric and LUQ pain with anemia. History of Present Illness:        Patient is a 56-year-old male. He reports a long history of mild dyspepsia characterized by burning epigastric pain, especially when his stomach is empty. Over-the-counter antacids have relieved this pain. Approximately two weeks ago, the pain became significantly worse; he is also nauseated and has vomited several times. Past Medical History:                Patient’s history is not significant for other digestive system disorders. He had a tonsillectomy at age 8. He sustained a compound fracture of the left ankle in a bicycle accident at age 11 that required surgical fixation. More recently he has been diagnosed with an enlarged prostate gland, and surgery has been recommended. However, he would like to resolve this epigastric pain before going forward with the TUR. Results of Physical Exam:         CBC indicates anemia, and a fecal occult blood test is positive for blood in the feces. A blood test for Helicobacter pylori is positive. Erosion in the gastric lining was visualized on an upper GI. Follow-up gastroscopy found evidence of mild reflux esophagitis and an ulcerated lesion in the lining of the pyloric section of the stomach. This ulcer is 1.5 cm in diameter and deep. There is evidence of active bleeding from the ulcer. Multiple biopsies were taken, and they were negative for gastric cancer. IV Tagamet relieved the painful symptoms in two days. Assessment:                            Peptic ulcer. Gastric cancer has been ruled out in light of the negative biopsies. Recommendations:                  A gastrectomy to remove the ulcerated portion of stomach is indicated because the ulcer is already bleeding. Patient should continue on Tagamet to reduce stomach acid. Two medications will be added: Keflex to treat the bacterial infection and iron pills to reverse the anemia. Patient was instructed to eat frequent small meals and avoid alcohol and irritating foods.

This patient reports LUQ pain. What does LUQ stand for and what organs do you find there?

This patient had two diagnostic tests that indicated he was losing blood. Name these two tests (no abbreviations).

This patient had a procedure to visually examine the ulcer. Name the procedure done.

Name the serious pathological condition that was ruled out.

Answer 1

1. This patient reports LUQ pain. It means Pain in the Left upper quadrant.

Our abdomen and pelvic region are divided into 4 quadrants and 9 regions.

The Quadrants are 1. Right upper 2. Left upper 3. Right lower and 4. Left lower

2.

This patient had two diagnostic tests that indicated he was losing blood.

These are 1. Complete Blood Count(CBC) 2. fecal occult blood test (+)

Hematocrit and Hemoglobin level in CBC indicates there may be bleeding, Positive fecal occult blood test means there is the presence of Blood In stool.

3.

The patient had Gastroscopy to visually examine the ulcer.

Gastroscopy means the visualization of the Upper gastrointestinal tract. It also is known as Esophagogastroduodenoscopy. A thin endoscopic tube inserted into the upper GI tract by mouth to visualize the internal linings.

4.

The pathological condition which was ruled out in this patient is mild reflux esophagitis and an ulcerated lesion in the lining of the pyloric section of the stomach.

Reflux esophagitis is also referred as Gastroesophageal reflux disorder which is damages esophageal lining due to the backflow of stomach acid into the Esophagus.

Ulceration means infection, inflammation or sore in the esophageal, stomach and small intestine linings.